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COVID-19 Update 3/3: Metabolic Health, Which Vaccine Should You Take, and More

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On this week's COVID-19 update, Dr. Bishop discusses the importance of metabolic health and how it is the epidemic behind the pandemic, offers advice on which vaccine you should take (hint: the first one you can get), and more. Watch the video below and read on for a full transcript. 

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Metabolic Health: The Epidemic Behind the Pandemic

Today we're answering all your questions like we always do. But the main topic I want to talk about today is actually talking about the, the epidemic behind the pandemic. And you guys have probably seen and heard about this over the past year, and I've talked about it a few times during the course of the year, as COVID has kind of taken its toll on the U.S. And other places. But a study came out this week that really brings us back to the foray.

And that is the the unfortunate reality that the vast majority of Americans are metabolically sick, and that has really driven our hospitalization numbers and our fatality numbers and all of this horrible stuff that we've seen over the last year.

It's not just restricted to the U.S. Of course there are other countries that have lots of metabolic illness too, but the U.S. is by far and away one of the most metabolically sick populations on the planet.

What do I mean by metabolically sick? I'm talking about excess weight, obesity, diabetes, hypertension, pre-diabetes, strokes, heart attacks, all these things, can really be lumped into one thing, which is metabolic syndrome, metabolic disease. You may or may not have heard that syndrome, but essentially what it all means is that it's being driven by insulin resistance and by unhealthy food choices, typically eating lots of processed carbohydrates.

That's what's really been driving the lack of health of our population in general. If you look at the numbers for who ends up in the hospital, who ends up dying from COVID, yes, there are plenty of people who die with no underlying conditions. That's true. But far and away, most people who wind up in the hospital, wind up dying from COVID, are either very elderly or they have one or more of these symptoms of metabolic disease.

So diagnoses like hypertension, obesity, pre-diabetes, diabetes, these are all symptoms of metabolic syndrome, essentially.

60% of COVID Hospitalizations Could Have Been Preventable

And the American Heart Association actually just published in their journal a big study that was done on this.

They took the data from a large portion of people who were hospitalized in New York and compared that to national data, something called the NHANES dataset that tracks a lot of chronic medical conditions across the population, and did some extrapolations.

What they found is that about 60% of the hospitalizations that we've had in the U.S. in the past year from COVID could have been preventable if these patients didn't have one of these underlying metabolic disorders, such as heart disease, diabetes, obesity, high blood pressure.

Just a couple of these alone probably accounted for the majority of the hospitalizations. If you actually just take obesity alone, that means having a BMI of over 25, that accounted probably for 30% of all hospitalizations in the past year.

If you add diabetes to that, that accounts for 40%.

Really stark and startling information. This jives with things I've talked about before. About about 88% of our population has some metabolic abnormality. It really comes down to our food and what we're eating.

So while we've talked a lot about the vaccines and the masking and the hand washing and all that stuff, and all that stuff's important and has been important for the last year, I really just wanted to reiterate, since this study came out, the importance of getting your metabolic health in check.

Start really paying attention to what you're eating. Try to eat whole foods, real foods that come from the perimeter of the grocery store, as much as you can.

And I know that you've all probably heard that at some point, but it really is extremely important for your health. It's important for our nation's health, and that's really the epidemic behind what's going on with the pandemic. We're seeing the effects of all of this metabolic disease because of how sick people are when they encounter the virus to start with.

There's a lot of information in there, but it's really quite quite concerning to see all of this metabolic illness and the impact that it has had on COVID and the really terrible outcomes that we have seen from this as well.

So just some interesting food for thought today. So that's our message. If you're a PartnerMD member, we would love for you to join our MetabolizePMD program, which teaches you how to eat in a healthy way and gives you the support to do that.

If you're a member, just reach out. Let us know if that's something you're interested in and we will get you connected.

Everybody else, if you're not a member, please talk to your doctor. Please find a coach, start working on your food choices.

And it really can save your life for a whole lot of reasons, not just because of COVID, but it will prevent you from having a heart attack, strokes, and all the other bad outcomes from diabetes. So please take a look at this this study and really think about a lot of what's going on here behind the COVID pandemic.

Cases and Deaths Declining

I just want to reiterate that we're still seeing reductions in cases and deaths across the country, which is good. Not slowing down as much as it had been, so we've kind of gotten off to a little bit of a plateau, but I suspect the numbers will probably keep trending down over the next few weeks.

Deaths have dropped, too, thankfully. Not as much as we would like and still running an outrageous 1,000 or more a day. Again, it's not like the virus has disappeared at this point, but I'm hoping as we get into the spring that the numbers will keep going down, especially as the vaccine numbers keep increasing.

Which Vaccine Should You Take? 

A common question is, well, which vaccine should I take? Should I take J&J? Moderna? Pfizer?

My blanket recommendation for people, if you're looking for vaccine, take the one that's available. Don't wait.

I do agree with Dr. Fauci on this. Take the one that's available to you. Don't try to wait for a particular one or another. They're all pretty effective and will be fine to use.

The J&J one seems to actually have perhaps fewer side effects, or if you're worried about side effects, the J&J one might be one to look for, but that being said, I would not hold off on getting it. If you're planning to get it, don't hold off on getting it to wait out for a particular brand of it. Just get whichever one's available to you.

Guidance for Vaccinated People with Other Vaccinated People

"Can you give clear rules of how vaccinating people can behave now with other vaccinated people?"

Yeah, I think for the most part and I think the data, but also the recommendations coming out of CDC are marching along in step with this pretty steadily and I think they're going to continue to liberalize over the next couple of weeks to months.

I think for the most part, if you've been vaccinated fully, and it's been the two weeks since the second dose and you're interacting with other vaccinated people, in my opinion, I think you can pretty much act normally with them.

I don't think you need to be masking with them. I don't think you need to take any specific precautions at that point with those folks. Unless people are sick, right? If you have symptoms, if you don't feel well, then please do do all those things.

But if you're well and not having any symptoms, I don't think there's any reason not to essentially behave normally around them as you would have in the past, especially if everybody you're around is vaccinated.

"Universal" COVID Vaccines

"Dr. Fauci talked this morning about efforts to develop a universal COVID vaccine that will cover any variants and potentially future coronaviruses. How would that work?" 

Yeah, it's the same idea behind trying to develop a universal flu vaccine, which has been a sort of a holy grail for scientists for a long time.

The idea is to find a piece of the virus's genetic and protein code that does not change very much and a targeted immune response to that so that whatever you do, whatever vaccine you end up creating, is really focused on that piece of the virus that almost never changes.

It doesn't seem to have worked out very well for flu vaccine to date. The immune responses just aren't robust enough to the vaccines they've used.

We may find the same problem with the COVID virus as well, that the immune response to the unchanging portion of the virus just aren't very strong. And there is a lot we could go into that, but one of the primary reasons for that is the part that keeps changing on the virus is the part that is used to dock with the human cells.

And so the human body and the virus are in this constant tit for tat arms race. As the immune system adapts to that part of the virus, which is actually what allows the virus to get in the cell and creates antibodies against that, then the virus then changes genetic structure from natural mutation rate, etc.

Then the body has to adapt again and that's why that whole part of our immune system is called the adaptive immune system, because it's constantly changing. If the immune system isn't really incentivized to create an antibody against the part of the virus that is not involved in attachment and not being shown or presented, I know that that's a little bit of a funny word to say, but it's the part of the virus that is available to the immune system, to the antibody response, the "presented" part of the viral particle that attaches to the cell.

Some of these other parts of the virus that, that aren't presented, they're just not a good target for the immune system. I know that's a little bit of a convoluted response, but the flu vaccine sort of has had the same problem. That would be great if we had a universal vaccine, but I think that that's going to be a real challenge for the same reasons we've had problems with getting the universal flu vaccine. That's why we have to get flu shot every year.

Checking for Antibodies

"What if people aren't vaccinated yet, but supposedly have antibodies. How often should people be checked to see if they still have antibodies?"

Yeah, I think same thing. If people have had the virus, most people are good for 90 days at least. I think if people are more than 90 days out, then they probably at that point need to either get vaccinated or have their antibodies rechecked. But generally about 90 days is considered a safe window at this point after infection.

"Can we be with people who have been checked for antibodies? How recently should they be checked to be certain they're still covered?"

Yeah, I think you know, if they're less than 90 days out from infection, I think they're certainly fine. If they wanted to check every few months after that, until they get vaccinated, I think that's a reasonable approach to take.

Waiting for Vaccines

"We are still waiting for vaccine. Do you think more places like CVS, Walgreens, and the like will be able to get vaccines soon?"

I hope so, but I have no idea. We have been told that we may be able to order more vaccine in the coming weeks from the health department for 65 and up. Not for anybody younger than that at this point.

I would suspect that that means that supplies are increasing. But again, the state is only allowing 65 and up right now. And so I think that's going to be the same at your CVS or Walgreens or whatever.

They're probably going to keep holding to the same guidelines that the state health department is following. And they'll probably all change in tandem. I wouldn't expect that to change any time in March.

The health department pretty clearly told us that they did not expect to go down to younger ages or a more general 1B category people until toward the end of March. So I think that that's not going to change for this whole month, unfortunately.

Note: Dr. Bishop will be out of the office for the next two weeks for continuing education. We will take next week off. Our next update will be on Wednesday, March 17, as Dr. David Pong will fill in for Dr. Bishop.